Starting an IV with Lidocaine or Not?

[hayest]

I recently had surgery. My physician actually started the IV without Lidocaine. He knew I wanted the area numbed before the IV was placed. I've heard the reason before from other nurses and now him..... Lidocaine can hide the vein to cause a 2nd stick. I was willing to risk it. I wanted him to use the Lidocaine and I thought he was. He found the vein, said "here's a stick", (i felt nothing -- thinking this is great), then he said "here's a stick" and OMG .. that hurt like hell. I was VERY upset with him. I haven't had the opportunity to ask him why he didn't use Lidocaine. I know he told the preop nurse that if he could not start it, he would have her do it. I knew he was nervous. Keep in mind, he starts IV's all the time, just not in front of a lot of people. I had everyone leave the room and it was just him and me. Not only do I want to know why he did not use Lidocaine, but why didn't he ask me again and why didn't he give me the chance to ell him that I would allow him to try a few times. He did bring up after starting it "now I know where I can start the IV - next time, we will put creme on your hand to numb it". My reply was "a little late in saying that". What is the consensus of using lidocaine to start IV's or not?

[KelRN215, BSN, RN]

Kudos to the hospital for the protocol of "asking patients what they want". Hospitals, nurses, physicians, etc. should ask what the patient wants.

What the patient wants and what's medically appropriate are not one and the same...

[Rose_Queen, BSN, MSN, RN]

My facility's preop standing orders include a lidocaine injection, but it is up to the patient whether or not it is used. Personally, just stick me once (or twice if needed) and get it over with- skip the extra stick with the lidocaine.

[esipbisn]

It's a really interesting thread giving that any med-surg, step down RN even PACU would look at you funny for wanting to use it. Never heard of it. But why not I guess

[pixiestudent2]

Hmm... I never thought IVs hurt that bad... I don't like the anticipation, but the actual act of inserting one never really caused an excessive amount of pain...

[applewhitern, BSN, RN]

I have never worked in a hospital that would allow us to use lidocaine for IV sticks. The physicians can use it, of course, but not the nurses. I have used Emla for kids, but usually it takes too long and really doesn't seem to work that well. I am sorry your physician ignored your request. That said, I would rather just get the IV done with.

[NanaPoo]

I've had LOTS of IV sticks and they're always when I'm dehydrated and super low on potassium. I'm a hard stick then. I don't find them all that painful as long as I get a warning and can take a deep breath at the time of the stick. It usually takes at least 2 tries to get a successful line in me. I can deal, though.

In 16 years of nursing experience and all my times of being stuck I've never seen or heard of Lidocaine being an option with an IV start. At least not with adults.

[FlyingScot, RN]

I've never used it and don't intend to start. I've seen too many unsuccessful sticks with it. An IV insertion in the hands of a skilled clinician should be absolutely tolerated by a grown adult. Personally I think the best way to avoid pain is to really assess the available veins, choose an appropriate site and sized catheter, don't make a big deal about it. I also don't dig, fish or stick more than twice (unless you're going to die then all bets are off). I rarely have to stick twice and more often then not have the line in before the patient even knows it. I don't have the patient clench their fist and I don't have them take a deep breath. I just distract them with my scintillating conversation. This has worked for me for almost thirty years on neonates to geriatrics.

[brownbook]

We can use lidocaine, many co-workers routinely do. I have problem using lidocaine. It obscures the vein, the bleb site bleeds a little, the bleb ends up not being where I want to poke the vein, etc. I guess if it was mandatory and I used lidocaine every time I would get the hang of it?

The only thing 100% certain about IV's (I've been working out patient surgery for 15 years now....we start all the pre-op IV's) is that every patient is different. Every vein in their hand, forearm, antecubital fossa is different from the next patient's veins. The way patients react to the stick is different. Everybody feels pain differently.

I always ask the patient where do you prefer the IV to go. I don't ask if they want lidocaine but if a patient tells me to use it I would. (Or probably get a co-worker who uses it regularly.) Your doctor was wrong to ignore your request.

[Anonymous865]

What the patient wants and what's medically appropriate are not one and the same...

A lot of what is done has nothing to do with "medically appropriate" and everything to do with what is most convenient for staff or what someone has decided that every patient wants or provider preference or any number of other reasons.

If using or not using lidocaine were decided on medical appropriateness, then why are some hospitals using it on every patient yet other hospitals are using it on no patients and some hospitals are using it on select patients?

Every patient gets a hefty dose of Versed before surgery. Why? Someone decided that no patient wants to remember anything about the OR. Of course that's not true. Some patients are adamant they want to remember nothing. Some patients don't care one way or another. Some patients are very distressed by the fact they can't remember anything.

When to remove foley catheters is another one. Catheters are always removed at 6am or 8am per policy. Why? If the patient can't void in 4 hours, you don't have to disturb the provider after hours to get an order to cath the patient. It is not more medically appropriate to remove it at 8am than it is at 4pm.

Patients aren't asked their preference because it would slow down the assembly line.

[CBlover, BSN, RN]

Never use it.

[brownbook]

Actually what the patient wants is 100% medically appropriate.

Unless they are unconscious in a life and death situation a patient has the right to refuse any treatment. It is assault and battery to do any procedure on a patient if they say to you I don't want that.

I read or heard once that you can't cut a patients hair without their consent. Sounds odd to bring it up but when I worked ICU the long term vent patient's would get horribly matted hair. I would cut it, of course it is a kind of silly, no patient or family ever noticed or sued me! (Actually a co-worker noticed once....she said something about the patient in bed 3 is so sick their hair is falling out! I just kind of let that one slide!)

Yeah we can get into minors, mental illness, dementia, Alzheimers patients etc. but even they have a lot of rights to refuse treatment.

[NICUmiiki, DNP, NP]

When I had surgery, I refused the lido. I just wanted her to get it over with. While obviously I think getting stuck hurts, I just don't think that it's a significant amount of pain to warrant any sort of pain med.

I didn't even realize my hospital did that until my visit to same day surgery. In the ED, we simply do not use lidocaine for sticks.